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PubMed2005

The effects of injection of bovine vaccine into a human digit: a case report.

BACKGROUND: The incidence of needlestick injuries in farmers and veterinary surgeons is significant and the consequences of such an injection can be serious. CASE PRESENTATION: We report accidental injection of bovine vaccine into the base of the little finger. This resulted in increased pressure in the flexor sheath causing signs and symptoms of ischemia. Amputation of the digit was required despite repeated surgical debridement and decompression. CONCLUSION: There have been previous reports of injection of oil-based vaccines into the human hand resulting in granulomatous inflammation or sterile abscess and causing morbidity and tissue loss. Self-injection with veterinary vaccines is an occupational hazard for farmers and veterinary surgeons. Injection of vaccine into a closed compartment such as the human finger can have serious sequelae including loss of the injected digit. These injuries are not to be underestimated. Early debridement and irrigation of the injected area with decompression is likely to give the best outcome. Frequent review is necessary after the first procedure because repeat operations may be required.

Accidents, Occupational↗
PubMed1988

HIV infection: risks to health care workers and infection control.

The risk for occupational transmission of HIV-1 in the health setting is extremely small. Current data from a number of prospective studies of health care workers sustaining adverse exposure to blood or other body fluids from patients infected with HIV-1 demonstrate that the rate for transmission of infection following a needlestick injury is approximately 0.5%. Similar data regarding the risk for occupational transmission of hepatitis B virus infection, however, indicates that the rate of transmission of infection with this virus following a needlestick injury may be as high as 30% and the risk for transmission of other blood-borne infections is poorly defined. Infection control precautions designed to minimize the risk for HIV-1 infection were recommended by CDC shortly following the first reported case of AIDS in the United States. These measures were implemented for patients diagnosed with or suspected to be infected with HIV-1, determined by history-taking or serologic evaluation. The inability of these mechanisms to accurately identify all infected individuals, coupled with the occurrence of undiagnosed or unrecognized blood-borne infections, emphasizes the need for health care workers to consider all patients as potentially infected with HIV-1 or other blood-borne pathogens. Implementation and enforcement of universal precautions should minimize exposure of health care personnel to blood and body fluids and thus substantially reduce the risk for occupational transmission of HIV-1 and other blood-borne infections in the health care environment.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Does clinical experience affect medical students' knowledge, attitudes, and compliance with universal precautions?

OBJECTIVE: To investigate differences in second-, third-, and fourth-year medical students' knowledge of bloodborne pathogen exposure risks, as well as their attitudes toward, and intentions to comply with, Universal Precautions (UP). DESIGN: Cross-sectional survey. PARTICIPANTS AND SETTING: Surveys about students' knowledge, attitudes, and intentions to comply with UP were completed by 111 second-year (preclinical), 80 third-year, and 60 fourth-year medical students at Washington University School of Medicine in the spring of 1996. RESULTS: Preclinical students knew more than clinical students about the efficacy of hepatitis B vaccine, use of antiretroviral therapy after occupational exposure to human immunodeficiency virus, and nonvaccinated healthcare workers' risk of infection from needlestick injuries (P<.001). Students' perceived risk of occupational exposure to bloodborne pathogens and attitudes toward hepatitis B vaccine did not differ, but preclinical students agreed more strongly that they should double glove for all invasive procedures with sharps (P<.001). Clinical students agreed more strongly with reporting only high-risk needlestick injuries (P=.057) and with rationalizations against using UP (P=.008). Preclinical students more frequently reported contemplating or preparing to comply with double gloving, wearing protective eyewear, reporting all exposures, and safely disposing of sharps, whereas students with clinical experience were more likely to report compliance. Clinical students also were more likely to report having "no plans" to practice the first three of these precautions (P<.001). CONCLUSIONS: Differences in knowledge, attitudes, and intentions to comply with UP between students with and without clinical experience may have important implications for the timing and content of interventions designed to improve compliance with UP.

Adult↗
PubMed1991

Aspects of 'safe' surgery.

The differing concern among surgeons regarding the blood-borne transmissible infections HIV and hepatitis B virus (HBV), has prompted a confidential questionnaire of 250 consultant orthopaedic surgeons on some aspects of their current practice of 'safe' surgery. Only 154 replied. Hepatitis B vaccine uptake by surgeons was 70 per cent in this sample. This compares favourably with two recently published figures (47 per cent and 24 per cent). Unfortunately, we do not fare as well on routine screening for HBV in known 'at risk' groups, although 92 per cent of surgeons felt confident that they would recognize the 'inoculation risk' categories. The response to sustaining a needlestick injury by the majority of surgeons (87 per cent), was to change the affected glove. Only 7 per cent reported the incident as recommended to the Occupational Health Department and 6 per cent took no action at all. Current recommendations for 'safe' surgical practice as they apply to surgeons with regard to needlestick injury are discussed.

Adult↗
PubMed1991

Occupational HIV infection and health care workers in the tropics.

A literature review revealed 33 reports of health care workers who have contracted HIV infection as a result of their work. Four of these were expatriate doctors who had worked in Africa. The commonest mode of transmission was needlestick injury, but several infections acquired through contact or skin or mucous membrane with infected blood have been reported. In this paper we outline how the risk of HIV infection in a health care worker can be estimated for a given number of exposures. The formula is based on the known likelihood of transmission per needlestick, the seroprevalence rate among patients, and the number of needlestick injuries that occur. We also suggest a list of measures by which the risk of HIV transmission to hospital staff can be minimized.

HIV Infections↗
PubMed2004

Impact of safety devices for preventing percutaneous injuries related to phlebotomy procedures in health care workers.

BACKGROUND: Use of protective devices has become a common intervention to decrease sharps injuries in the hospitals; however few studies have examined the results of implementation of the different protective devices available. OBJECTIVE: To determine the effectiveness of 2 protective devices in preventing needlestick injuries to health care workers. METHODS: Sharps injury data were collected over a 7-year period (1993-1999) in a 3600-bed tertiary care university hospital in France. Pre- and postinterventional rates were compared after the implementation of 2 safety devices for preventing percutaneous injuries (PIs) related to phlebotomy procedures. RESULTS: From 1993 to 1999, an overall decrease in the needlestick-related injuries was noted. Since 1996, the incidence of phlebotomy-related PIs has significantly decreased. Phlebotomy procedures accounted for 19.4% of all percutaneous injuries in the preintervention period and 12% in the postintervention period (RR, O.62; 95% CI, 0.51-0.72; P < .001). Needlestick-related injuries incidence rate decreased significantly after the implementation of the 2 safety devices, representing a 48% decline in incidence rate overall. CONCLUSIONS: The implementation of these safety devices apparently contributed to a significant decrease in the percutaneous injuries related to phlebotomy procedures, but they constitute only part of a strategy that includes education of health care workers and collection of appropriate data that allow analysis of residuals percutaneous injuries.

Health Personnel↗
PubMed1999

Preventive health behaviour among general practitioners in Victoria.

UNLABELLED: This study describes the preventive health behaviour of general practitioners in Victoria, with particular emphasis on hepatitis B prevention, and their use of medical services, and seeks to explain these behaviours. METHODS: Cross sectional postal questionnaire survey of a 10% random sample (n = 544) of all GPs in Victoria, Australia. RESULTS: A valid response rate of 58.5% was achieved. Only 4% of the sample smoked, 93% had a blood pressure check in the past 3 years, and 64% had a cholesterol check in the past 3 years. About half followed a 'healthy' diet and 20% took a high level of physical exercise. With regard to hepatitis B prevention, 87% had completed vaccination, and 49% had confirmed immunity. Needlestick injuries had been suffered by 49% in the previous year, and half of the respondents would take no action after such an event. Over two-thirds (69%) reported having no GP. Psychological factors were associated with preventive health behaviour independent of age and gender. Internal locus of control and health value were positively associated with whether the doctor would take any action after needlestick injury, had a blood pressure or cholesterol test in the past 3 years or had their own GP. CONCLUSION: This study shows that GPs in Victoria have a relatively high level of preventive health activity although they have a low level of utilisation of their GP colleagues in service provision. There are measurable differences in psychological variables between doctors that are associated with their level of preventive care. Plans to improve their personal health care should concentrate on psychological well being.

Adult↗
PubMed1991

[Stab wounds and lacerations among operating room personnel].

In order to illustrate frequency of peroperative accidental needle-stick injuries and lacerations among operation theatre staff, the theatre staffs in the Central Hospital in Hillerød (CH), the County Hospital in Roskilde (ASR) and the St. Elisabeth Municipal Hospital in Copenhagen (SE) were requested to complete a questionnaire after every operation in which they had participated. This investigation took place during a period of three months in CH and two months in ASR and SE. A total of 861 questionnaires were completed with a percentage of replies of 54.4. Of these, 355 (41%) were gynaecological/obstetric interventions, 297 (35%) orthopaedic surgical interventions and 188 (22%) general surgical while 21 (2%) were unspecified. A total 187 (21.7%) cases of holes in the gloves, 47 (5.5%) accidental needlesticks and two (0.23%) accidental lacerations. The frequency of needlestick injuries was greater during gynaecological operations than with the orthopedic surgical and general surgical operations. No differences were observed in the average durations of operation in cases of lesion or total number of lesions. Among the operations, 657 (76.3%) were elective operations, 168 (19.5%) were emergencies and 36 (4.2%) were unspecified. Thirty (4.6%) of the needlestick injuries occurred during the elective interventions and 14 (8.3%) during the emergency operations. As a rule, it was the operating surgeon who injured himself with a needle and the commonest site of the lesion was the pulp of the left index finger. Only one of these lesions had been notified as an occupational injury.

Accidents, Occupational↗
PubMed1990

An effective educational program to reduce the frequency of needle recapping.

We developed an educational program that reported the rate of needle recapping to healthcare workers, in conjunction with emphasis on appropriate disposal procedures. Over 12 months, the rate of recapping needles used for venipuncture and for percutaneous medication injections fell from 61% to 16% (p less than .0001). Over the same period, the recapping of needles used primarily for intravenous (IV) administration fell from 44% to 33% (p = .03). Re-evaluation of the rate of recapping eight months later showed a continuation of these lowered rates. Needlestick injuries were too few in number during the study period to detect any change accompanying the decreased recapping rate. We conclude that programs that report back to employees their rate of recapping can significantly reduce this activity in the disposal of needles used for venipuncture and for percutaneous medication injections. While such reporting may reduce the rate of recapping of needles used for IV administration, the effect is not nearly so marked. Modifications in design remain the most promising approach to preventing needlestick injuries from recapping needles used for IV administration.

Cross Infection↗
PubMed1990

Noncompliance with Universal Precautions Policy: why do physicians and nurses recap needles?

In 1987 the Centers for Disease Control published a Universal Precautions Policy establishing blood and body fluid procedures to be used consistently with all patients. An important and unequivocal Universal Precautions Policy recommendation with regard to avoidance of needlestick injuries is that needles should never be recapped. We examined the recapping-related attitudes and behaviors of physicians and nurses at four large teaching hospitals with patients with acquired immunodeficiency syndrome and with Universal Precautions Policy in-service training programs. Compliance was found to be considerably less than optimal. According to unannounced needle counts in disposal boxes, the percentage of recapped needles was always greater than 25% and exceeded 50% in four instances. Recapping was related to inadequate knowledge, concerns about personal risk, forgetfulness, being "too busy" to follow the Universal Precautions Policy, and the misperception that recapping is a way to avoid needlestick injury. Strategies are suggested to improve and supplement traditional in-service education.

Communicable Disease Control↗
PubMed1996

Infection control practices in the home: a survey of households of HIV-infected persons with hemophilia.

OBJECTIVE: To assess infection control practices and risk for human immunodeficiency virus (HIV) transmission in households where home infusion for hemophilia is used. DESIGN: Cross-sectional prospective survey from 1992 through 1994. SETTING: Hemophilia treatment centers. PARTICIPANTS: Human immunodeficiency virus (HIV)-infected persons with hemophilia who receive home infusions of clotting factor concentrate and their household members. MAIN OUTCOME MEASURES: Frequency of specific infection control practices in the home and the risk of HIV transmission to household members. RESULTS: We surveyed 235 persons from 75 families (79 HIV-infected persons with hemophilia and 156 household members) about infection control practices in the home. Forty-eight percent of household members surveyed helped with the infusion process. Of 74 members who assisted with infusion, 13 (18%) had sustained a needlestick injury, 11 of whom were injured during the past year. One hundred fifty household members tested for antibody to HIV were antibody negative. These household members had a total of 903 person-years of contact after HIV was diagnosed in the index case. Household members' adherence to recommended infection control measures was highest for washing hands after cleaning up infusion equipment and waste, and for using sharps disposal containers. Adherence was lowest for wearing gloves when helping with infusions and proper disposal of bloody waste from the infusion. CONCLUSIONS: No HIV transmission was found among persons living with HIV-infected persons with hemophilia, although there was a high rate of needlestick injuries during home infusion. Because persons who assisted with infusions often did not wear gloves and many households did not dispose of bloody waste properly, hemophilia treatment center personnel should emphasize these areas when training for home infusion. Adherence to appropriate infection control practices should help to keep the risk of HIV transmission in households extremely low.

Adolescent↗
PubMed1991

Attitudes of paediatricians to HIV and hepatitis B virus infection.

There is a recent upsurge of interest among health care professionals regarding the risk of accidental occupational exposure to HIV virus. We evaluated knowledge of virus carriage prevalence, needlestick injuries, venepuncture practices, and glove use among paediatricians in Wales and South West Regional Health Authorities. We also attempted to evaluate hepatitis B immunisation uptake in this group. Paediatricians have traditionally been considered a low risk group in the context of accidental occupational exposure to these viruses. We targeted a four point questionnaire at 221 paediatricians. Results suggested that despite recent increasing concern about these viruses, that is reflected in the amount of medical literature recently published, and the issuing of Department of Health guidelines on venepuncture, knowledge of prevalence of HIV and hepatitis B carriage rates, and hence assessment of risk magnitude, was surprisingly poor. Safe venepuncture practices were not widely used. In the 12 months before receiving the questionnaire 55% had suffered a needlestick injury with only 10% reporting the fact. Hepatitis B immunisation uptake was highest in the junior grades (but this does not necessarily mean those at greatest risk). There were many inconsistencies between the clinicians' perceptions of risk and their practices. As the virus attains a firm hold in the heterosexual population paediatricians by virtue of the nature of venepuncture in children will almost certainly see their risk of acquiring HIV/hepatis B viruses secondary to accidental occupational exposure increase over the next decade. Without an improvement in current knowledge of carriage prevalence in high risk areas and alteration in venepuncture practices/hepatitis B immunisation uptake some will unfortunately, though avoidably, contract these bloodborne viral infections.

Child, Preschool↗
PubMedDate not supplied

Improper office disposal of needles and other sharps: an occupational hazard outside of health care institutions.

An employee of a private disposal company suffered a finger needlestick injury while collecting waste at curbside from a building containing medical offices. Subsequent inspection of the contents of the garbage bags revealed the presence of used syringes and unsheathed needles. The Ministry of the Environment has developed a regulation and guidelines for the handling and disposal of biomedical waste including needles and other sharps. These specify that approved carriers and receivers are required for disposal; properly decontaminated waste is considered non-hazardous solid waste and can go to landfills. However, responsibility for curbside pickup of waste lies with municipalities; some municipalities have enacted by-laws which prohibit collection of this waste at the curbside. This incident illustrates that improper disposal of biomedical waste (including that from private practitioners' offices) may occur despite efforts to control its handling, and that needlestick injuries can occur outside of health care facilities among personnel who are not health care workers. Efforts are needed to increase the level of awareness among health professionals regarding their responsibility to ensure proper biomedical waste disposal from private offices. In addition, efforts should be made to bridge the gap between all levels of government regarding the disposal of biomedical waste.

Accidents, Occupational↗
PubMed1988

Controversies about guidelines to prevent the transmission of human immunodeficiency virus in hospitals in Britain.

The widespread screening of donors of blood, organs and semen for HIV antibody has contributed greatly to the prevention of spread of HIV to patients in British hospitals. The chances of patients acquiring HIV from a contaminated blood transfusion are now estimated at less than 1 in 1 million and factor VIII for haemophiliacs, which is also heat treated, is now virtually always free of HIV contamination. However, the wider use of HIV antibody tests to identify infected patients and rationalize the application of additional 'inoculation risk' precautions, so as to protect staff, is controversial. The risks of hospital staff acquiring HIV following occupational exposure, without such a screening-programme, are extremely low provided a high standard of hygiene is maintained and inoculation injuries are avoided. When needlestick injuries occur, involving HIV infected patients, the chances of transmission of HIV to hospital staff are less than 1 in 100. Current guidelines in Britain depend on use of additional inoculation precautions for patients belonging to HIV risk groups but in practice most of these 'risk patients' are not infected with HIV. Screening HIV antibody tests, preferably with consent, can help the smooth running of operating theatres in areas where many 'risk patients' require surgery, as extra precautions are not necessary for most of these patients who are HIV negative. All antenatal patients should be screened especially in areas of high prevalence of HIV, as this helps to prevent vertical transmission as well as facilitating the rational use of extra precautions to protect health care workers.

Acquired Immunodeficiency Syndrome↗
PubMed1999

A sharper point on using safer needles.

National legislation is just one sign of changing attitudes about safety needles. Fifteen states are considering similar bills; five already have passed such laws. OSHA also says it will put needlestick injuries on its agenda this fall. Yet if needlesticks and efforts to prevent them are nothing new, what's causing this change of heart? Two things: improved technology and media attention.

Equipment Design↗
PubMed2004

Needlestick and sharps injury prevention.

Every day while caring for patients, nurses are at risk to exposure to bloodborne pathogens potentially resulting in infections such as HIV or hepatitis B and C. These exposures, while preventable, are often accepted as being a part of the job. In the United States, needlestick injuries have begun to decrease from an estimated one million exposures per year in 1996 to 385,000 per year in 2000. This decline has resulted from the protections afforded by the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens Standard. Reasons for the success in decreasing needlestick and sharps injuries may be attributed to the elimination of needle recapping and the use of safer needle devices, sharps collection boxes, gloves and personal protective gear, and universal precautions. The prevention of needlestick injuries has made slow progress over the past 20 years since the HIV epidemic drew attention to the deadly nature of health care work and to protection of health care worker health and safety. In Africa, where the AIDS virus originated and where the prevalence of the human immunodeficiency virus (HIV) among hospitalized patients is highest in the world, attention has been directed only recently at protecting health care workers. Nurses, especially those infected from a preventable exposure, have been at the forefront of advocacy for prevention. This article includes a review about the hazard of exposure to bloodborne pathogens and epidemiology of occupational infection. The author discusses how to apply standard methods of occupational health and industry hygiene using the hierarchy of controls framework to prevent exposure to blood, and discusses evidence-based prevention and efficacy of particular control measures. Legislative progress and implementation of enforceable policy to protect health care workers is outlined.

Evidence-Based Medicine↗
PubMed1999

Bloodborne pathogens: toward safer needles.

California leads the way in protecting workers with sharps injury prevention devices. This article discusses the state's legislation to prevent needlestick injuries among healthcare workers and its impact. A chart to be used as a sharps injury log is provided.

Blood-Borne Pathogens↗
PubMedDate not supplied

Epidemiology of needlestick and sharps injuries among professional Korean nurses.

Although needlestick and sharps injuries (NSI) are known to affect professional nurses at high rates, most studies depend on officially reported data and few have been undertaken in Korea. Thus, we surveyed a large cross-section of nurses from a hospital in Gangneung (response rate, 97.9%). Four hundred thirty-two incidents of NSI were reported by 263 nurses (79.7%) in the previous 12-month period (average, 1.31 events/nurse/year). Syringe needles were the most common devices, affecting 67.3% and comprising 52% of all NSI events. Sixty percent of all NSI events involved contaminated devices. Opening an ampoule or vial was the most common cause (affecting 35.2% of all nurses and accounting for 15.9% of all NSI events). Logistic regression indicated that nurses working in "other" departments were 5.4 times more likely to suffer any NSI (odds ratio [OR] = 5.4; 95% confidence interval [95% CI] = 2.0-15.2; P < .05) and 4.7 times more likely to incur a syringe-needle injury than nurses in intensive care units or inpatient departments (OR = 4.7; 95% CI = 2.0-11.6; P < .05). Younger-than-average nurses (< 27 years) were 4.5 times more likely to suffer NSI (OR = 4.5; 95% CI = 1.7-12.6; P < .05) and 3.1 times more likely to incur a syringe-needle injury (OR = 3.1; 95% CI = 1.4-7.0; P < .05). Working mixed shifts also increased the risk of any NSI (OR = 4.0; 95% CI = 1.7-10.4; P < .05) or syringe-needle NSI (OR = 4.4; 95% CI = 2.0-10.1; P < .05). Overall, our study suggests that NSI are common among Korean hospital nurses and represent a significant occupational burden for this large Asian demographic. Intervention and preventive strategies to help reduce their NSI exposures are urgently required in this country.

Accidents, Occupational↗